Cardiology Coding Alert

Question: Somebody in our practice is recommending we report 93621 and 93624 for pre- and postablation electrophysiology studies. I have always been told not to bill for any procedure performed to verify or validate that a primary treatment is successful. Am I correct?

California Subscriber

Answer: Yes, you are correct. These codes should not be reported together during the same session because it is unbundling.

This is consistent with coding guidelines that state that procedures performed solely to verify or validate a primary treatment usually should not be reported separately.

Code 93624 (Electrophysiologic follow-up study with pacing and recording to test effectiveness of therapy, including induction or attempted induction of arrhythmia) is designed to report a followup electrophysiologic (EP) study on a patient who has previously had corrective therapy for arrhythmias. If 93624 were performed in a completely separate operative session on the same day, it could be reported with modifier -59 (Distinct procedural service) to indicate why the study had to be performed separately.

In most cases, however, follow-up studies are performed after ablations (which, in turn, follow initial EP studies) during the same session and are incidental to the ablation. Testing the effectiveness of the therapy (the ablation) during the same session is part of the treatment and part of the diagnostic EP study (93621), and it would not be reasonable for the cardiologist to conclude the ablation without checking to see if it was successful. Therefore, 93624 should not be reported.

Additionally, the follow-up EP study described by 93624 does not require the placement of EP catheters, because these were placed during the earlier EP study and/or the ablation.